How to Avoid Tearing in Childbirth

For this blog, I wanted to talk about how to avoid tearing during vaginal delivery. There are so many different factors that affect tearing such as how big your baby is, the position you are delivering in, the things you are doing before labor, and many more. I will include some tips and my personal experience as to how to avoid tearing during childbirth.

There are different grades of tearing and I will discuss them below before giving you tips.

The Different Grades Of Tearing

Sometimes, your provider will also cut you in the area between your vaginal opening and your anus, called the perineum, to avoid tearing. This procedure is called episiotomy.  Not everyone agrees on the necessity of an episiotomy.  Some practitioners feel as though episiotomies can make your tearing worse rather than better.  

First degree tears are the least severe and only involve the skin. They may or may not require stitches. There may be some stinging with urination. 

Second degree tears involve the skin and the muscles of the perineum. It may involve the vaginal wall as well. It will require stitches and takes a few weeks to heal. 

Third degree tears extend into the anal sphincter.  These need repaired and can require anesthesia to do so. It can also cause painful sex and fecal incontinence.  

The fourth degree vaginal tear is the most severe and it goes all the way into the rectum. This is going to require extensive repair under anesthesia and a lot of therapy afterwards to regain pain-free bowel movements, sex, sitting, and all sorts of things. Even with the fourth degree tear, you can still rehabilitate it and get back your function.

How To Prevent The Tears From Happening Ahead Of Time

One thing that can help prepare you for birth that you do prior to delivering would be perineal massage. The perineum is between the vaginal opening and the anal opening. Massage that area by asking your partner to do it or you can also do it on your own. You can even use a wand to massage this area. 

You can do this by lying on your back, on all fours, or standing with one foot up on a ledge.  Lying on your back may begin to get more difficult as you get bigger throughout pregnancy.  Try to be relaxed as possible when you are doing it.  You want to use either your hands or a vaginal wand.  You want to traction the area back towards your tailbone and then to either side.  I find it helpful to imagine the area softening as you work with it and during labor.  

You can also insert your finger or wand into the vaginal opening and traction towards both your tailbone, the bones that you sit on, and a variety of other angles. You can use a lubricant. Just keep in mind that you should use a water-based lubricant or a silicone-based lubricant if you are using a tool. Your vagina has a certain pH, which is 3.8 to 4.5 and you would not want to introduce something that has a greatly different pH. You can check the pH level of different lubricants in the packaging or their website so you can be sure. Do not mix a silicone tool with a silicone lubricant. I would not suggest using coconut oil because its pH does not match the vaginal pH.

The next thing you can do is indirect massage of the pelvic floor. Just last week, I posted a video on our office page on how to do some indirect pelvic floor massage. I used a tiny foam roller and a coregeous ball. A deflated coregeous ball is the least invasive thing that you can use.  The tiny foam roller is a little more intense than a normal sized foam roller. You can always vary the density to increase or decrease the intensity. You can also use tune-up balls. Know that the more surface area there is, the less intense it will be on the tissues. 

The foam roller I used in the video is narrower in diameter and it fits nicely between the bones you sit on and it accesses the pelvic floor a lot more directly. The coregeous ball is much more forgiving and softer.  You can deflate it down. You will try to breathe into it and as you inhale and exhale, you really want to visualize your pelvic floor yielding and relaxing to the surface that’s touching it. This will help with labor and delivery

With my patients who are having trouble going into labor, I bring up an anatomy picture so they can see what their cervix and pelvic floor looks like so they can imagine it softening, thinning, and accepting the baby. I also tell them to close their eyes so they can focus on visualizing these. I know that it sounds out there, but it definitely helps with the relaxation process. 

The other thing I like patients to do is the puppy pose and pelvic floor relaxation technique all the way throughout their pregnancy. These help prevent the spasming of the pelvic floor and give it a break from all the weight of the organs, the baby, the amniotic fluid, the placenta, and all the other things. We want to try to give it a rest multiple times a day to avoid spasming and extreme tension when it comes to the time to deliver.

These are all great to do all the way up until delivery.

My Experience In Avoiding A Tear During My Second Delivery

The game-changer when I had to deliver my ten-plus-pound, one hundredth percentile head baby was when my awesome midwife provided perineal pressure while I was laboring until it was time to deliver. I only had first degree tearing and did not even need stitches. I consider that a win.     

When I delivered my son, I was at a midwife center in Pittsburgh. I was able to choose any position and place for laboring and delivery.  For this pregnancy, I was most comfortable on all fours and it gave my midwife nice access to apply pressure with her hands to my perineum. 

I did not have an epidural or any medications and I could feel all the things related to the experience. I knew that my skin was being stretched to its limits and it needed a little help from the pressure given by my midwife. If you have an epidural and do not feel everything, you have no instinct to protect that area or to have someone protect that area for you. If you do choose the route to have an epidural, it might be something to consider to have your partner or nurse provide that perineal pressure for you even if you cannot feel that you need that support. Also, with epidural, it takes away the instinct to slow down and knowing that you are going too fast.

Coached Pushing Can Cause Tearing

Sometimes, practitioners feel the need to coach pushing when patients have an epidural because they cannot feel as much and they might not know when to push. However, even if you are already at 10 centimeters, that does not mean you are ready to push. With coached pushing, you might push before your body is physiologically ready and before your pelvic floor is ready to relax and let the baby come out. 

Ideally, you try to resist pushing with all your might until your body cannot do anything else besides push the baby out.  That is what I tried to do with my son as I was calmer and in a scenario that I felt more comfortable with.  I was able to really resist the urges to push until it was time for him to come out. Slow and steady wins the race.

Moving Into Different Positions

The other thing that can help prevent tearing during childbirth is moving into different positions. If your tailbone is scooped under, there will be less movement in getting the baby out through the pelvic outlet. If you have a big baby like I did, you will need every little millimeter of room to easily get the baby out. Getting on all my fours, I believe, was important for my labor.  

Conclusion

Just to conclude:

•         Slowing down the birth of your child and not trying to rush it will be better. Unless there is a complication or the baby is in distress because the baby’s life is always more important than these things. However, if it is a normal and risk-free delivery, slower is always better.
•         Perinneal massage, both direct and indirect, is really great to do beforehand.
•         Changing your positions often throughout labor is another thing because this can help your baby navigate its way through the pelvis and get out easily.
•         Perineal pressure by your partner or healthcare provider is another thing to keep in mind.

If you have any questions, you can drop it in the comment section or you send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

You can also check my TikTok account as I use the platform to educate viewers about movement, chiropractic education, yoga, pregnancy, and more! 

Thank you for listening and see you next week!